- The inflammation that accompanies acne breakouts can increase melanin production in the skin, leading to the appearance of postinflammatory hyperpigmentation.
- Skin care products that reduce melanin production, increase cell turnover and ease inflammation can help to treat postinflammatory hyperpigmentation.
- Over-the-counter (OTC) products containing hydroquinone, corticosteroids and retinol are effective treatments.
- Skin resurfacing procedures can address postinflammatory hyperpigmentation, however these procedures can also cause it to develop in patients with dark skin.
Hyperpigmentation is a condition characterized by the appearance of scattered patches of skin that are darker in color than the surrounding skin. It is caused by the clustering of excess melanin—the pigment that gives skin its color—in certain areas.
The form of hyperpigmentation that occurs following acne outbreaks is known as postinflammatory hyperpigmentation. Acne scars often form alongside this type of hyperpigmentation, but they are ultimately a separate skin concern with a distinct set of causes.
Postinflammatory hyperpigmentation (PIH), although not a serious condition, is a cosmetic concern that can take several years to fade, and in some cases may never resolve without treatment. Fortunately, a number of topical medications and professional procedures are available to reduce their appearance and even out skin tone.
What Causes Postinflammatory Hyperpigmentation?
Acne formation triggers an inflammatory response in the body, which leads to an increase in white blood cell activity in the affected tissues. This activity stimulates an increase in melanin production.
This excess melanin accumulates into clusters, which darkens the skin. This results in the appearance of the scattered darkened patches of skin characteristic of PIH.
Can Postinflammatory Hyperpigmentation be Treated?
PIH can be fully cleared over time, however this is typically a long and difficult process. A successful approach to treating postinflammatory hyperpigmentation will usually involve a combination of products and treatments.
Hydroquinone, vitamin C and aloe vera gel inhibit melanin production, which can lighten hyperpigmented areas of skin. Topical retinoids increase cell turnover, which helps to purge dark, hyperpigmented cells and encourages the growth of new, lighter-colored skin cells.
Professional skin resurfacing procedures such as chemical peels and microdermabrasion also increase cell turnover. Laser treatments can be used to target and destroy accumulations of dark pigmentation.
Certain ingredients can also combat PIH by suppressing the inflammatory response that causes it to develop. Corticosteroids and vitamin C creams are anti-inflammatory topicals that can be applied for this purpose.
OTC creams formulated for reducing the appearance of PIH typically feature a combination of ingredients that reduce melanin production, ease inflammation and increase cell turnover.
OTC products that treat PIH include:
- Hydroquinone cream
- Corticosteroid cream
Topical hydroquinone is an effective treatment for all types of hyperpigmentation. Hydroquinone inhibits the production of melanin by interfering with the activity of tyrosinase, the enzyme that activates melanin production. Over time, this produces a skin lightening effect that reduces the appearance of hyperpigmented areas.
OTC hydroquinone creams typically have a concentration of 2%. More powerful concentrations are available through prescription. An effective treatment regimen usually consists of applying a thin layer of hydroquinone cream to the face once or twice daily for 3–6 months.
Noticeable results may take anywhere from two weeks to two months, depending on the severity of the hyperpigmentation and the strength of the cream. If you do not notice any results after three months, be sure to stop the treatment and meet with your doctor to discuss other options.
Hydroquinone can sometimes trigger side effects such as irritation, inflammation and photosensitivity. If you experience persistent side effects, you should cease treatment, as this may be indicative of an allergy to the product.
Corticosteroids suppress inflammation by interfering with the molecular pathways involved in the body’s inflammatory response. While the application of corticosteroid cream will have no effect on hyperpigmented areas once they have developed, by reducing inflammation, it can help to prevent PIH from developing in the first place.
One study involving a group of patients who had undergone laser procedures found that applying a corticosteroid ointment significantly reduced their risk of developing PIH. Further research, however, will be needed to assess the efficacy of corticosteroids in treating PIH caused by acne.
Misuse of corticosteroids is associated with a range of unwanted and potentially dangerous side effects: redness, irritation, unwanted hair growth, skin discoloration and more severe breakouts. Before applying corticosteroid cream, be sure to consult a doctor or dermatologist.
Retinol is a low-potency retinoid that increases cell turnover. Topical application speeds up the rate at which new cells are generated and dead cells are purged. Excess melanin is shed along with layers of dead cells, and newly formed areas of skin appear lighter in color. Over time, this results in the reduced appearance of hyperpigmented areas and a more even skin tone.
Despite its benefits, retinol is unlikely to be an effective treatment for PIH on its own due to its low potency. Products used to treat PIH are typically formulated with a combination of retinol and other ingredients, such as hydroquinone and corticosteroids.
When they are performed correctly by skilled professionals, skin resurfacing procedures can be an effective treatment method for hyperpigmentation of all kinds. That being said, procedures performed with inappropriate tools or settings are a common cause of PIH. Before considering such treatments, always be sure to discuss your options with a doctor or dermatologist.
Professional treatments for PIH include:
- Prescription retinoid creams
- Laser treatment
- Chemical peels
Tretinoin is a prescription-strength retinoid that has been proven to reduce the appearance of PIH. It also plays a role in preventing PIH from developing by way of its acne-fighting effects, which include inhibiting comedone formation and reducing inflammation.
Tretinoin functions by speeding up cell turnover, like retinol. However, it is a far more potent product, and although it can offer more noticeable benefits, it also carries a greater risk of side effects. It is known to cause a reaction called retinoid dermatitis, characterized by skin dryness, irritation and scaling.
Laser skin resurfacing procedures tailored for treating PIH will typically involve a combination of ablative and pigment selective lasers. Ablative lasers remove the surface layer of skin, while pigment selective lasers function by targeting and destroying clusters of excess melanin.
As the targeted cells are destroyed, the new skin that regenerates appears less pigmented and closer to your natural skin color. The end result is a more even complexion with fewer visible hyperpigmented areas.
When the correct lasers and settings are used, laser treatments can be an effective treatment for PIH. However topical treatments are less expensive, less likely to cause side effects, and are equally or more effective. As such, laser treatments should only be used when topical treatments have proven ineffective in treating PIH.
Chemical peel treatments exfoliate the surface skin with the use of acidic solutions. Chemical exfoliation encourages cell turnover, leading to the development of new areas of skin that are more even in tone, and reducing the appearance of hyperpigmented areas.
However, chemical peels can worsen pigmentation issues if the wrong type of peel is used. They also carry a risk of other side effects, including irritation, inflammation and increased sensitivity to ultraviolet (UV) radiation.
Like other skin resurfacing procedures, microdermabrasion involves the removal of the top layer of skin so that new skin can form, with improved texture and a more even tone. Microdermabrasion procedures are performed with a handpiece that uses either a diamond tip or a jet of fine crystals to buff away surface skin.
Microdermabrasion also reduces melanin production, which makes it a suitable procedure for treating all types of hyperpigmentation.
Vitamin C and aloe vera are natural ingredients that have demonstrated some efficacy in treating certain forms of hyperpigmentation. Their melanin-reducing and anti-inflammatory properties are believed to have the potential to both reduce the appearance of PIH and soothe the inflammation that causes it to develop initially. Further research, however, will be needed to confirm these benefits.
Vitamin C, also known as ascorbic acid, is an antioxidant naturally found in citrus fruits and certain vegetables. It interferes with the activity of tyrosinase, reducing melanin production and therefore has skin lightening properties when applied topically.
Topical vitamin C has shown promise as a safe and mildly effective treatment for melasma, and its skin lightening and anti-inflammatory properties suggest its potential for treatment and prevention of PIH as well. Further studies will be needed, however, to properly gauge vitamin C’s effects on PIH.
The gel of the aloe vera plant is rich in aloesin, an anti-inflammatory compound that also impedes the activity of tyrosinase and reduces melanin production. Topical aloesin application has been found to reduce the appearance of hyperpigmentation caused by exposure to UV radiation.
Aloe vera has also demonstrated acne-fighting potential. A topical formulation that contained a mixture of aloe vera gel and tretinoin was found to be far more effective in treating acne than tretinoin used alone. These effects may help to reduce the chances of PIH developing by addressing its root cause.
Best Postinflammatory Hyperpigmentation Treatments for Dark Skin
PIH occurs most often in individuals with dark skin. This is because those with darker skin tones have more active melanosomes—the cellular structures responsible for the synthesis of melanin—in their skin cells. As such, inflammation caused by acne is more likely to trigger an overproduction of melanin resulting in PIH.
The inflammation caused by professional procedures such as chemical peels, laser treatments and microdermabrasion is also more likely to cause PIH to develop in those with darker skin tones. For this reason, if you have dark skin and are experiencing PIH—or another form of hyperpigmentation—it is advised to use an OTC cream to treat it.
Should OTC products prove ineffective, be sure to speak to a dermatologist for assistance in finding a prescription topical or professional procedure that is effective and safe for your skin.
How Fast Will You See Results?
How quickly you see results will depend on the severity of your PIH and the efficacy of the treatment method you select.
- OTC hydroquinone, corticosteroid and retinol creams take anywhere from 1 to 6 months of use before results are visible.
- Professional treatments will have quicker results, but after these abrasive treatments, your skin will need time to heal before results are visible.
- It is unclear how long it takes to see results from home remedies such as vitamin C and aloe, as these have not been widely studied.
Skin Care Routine for Postinflammatory Hyperpigmentation
Since acne is a primary cause of PIH, a skin care routine built around the prevention and treatment of this condition should be first and foremost a routine suitable for acne-prone skin.
While regular cleansing is essential, it is also important to avoid the use of products that have the potential to cause irritation and inflammation, as this can also exacerbate PIH.
Choose a cleanser containing gentle, active ingredients such as hyaluronic acid. If you use toners or exfoliants, be sure to select products that do not contain astringents such as witch hazel. Avoid products containing fragrances and preservatives as well, as these can also cause irritation.
Water-based moisturizers are preferable for acne prone skin, but if you use an oil-based moisturizer, be sure to select one that is noncomedogenic to avoid clogging your pores. Comedogenic moisturizers increase your risk of experiencing breakouts, which can worsen PIH.
Topical creams containing ingredients with skin lightening properties, such as hydroquinone, retinol and vitamin C, can be worked into your skin care routine to address hyperpigmented areas. When using these products, be sure to follow any included instructions to ensure safety.
Acne inflammation is one of the most common causes of PIH, a condition characterized by the appearance of scattered dark spots in the affected area of skin. While not serious, PIH is an aesthetic concern that can be difficult to treat. Those with dark skin are more likely to experience PIH.
OTC topical creams containing ingredients such as hydroquinone, corticosteroids and retinol are proven to reduce the appearance of PIH. Topical vitamin C and aloe vera gel may also accelerate the recovery process, however more research is needed to properly gauge their efficacy.
Prescription-strength retinoids, such as tretinoin, and professional procedures such as laser treatments, chemical peels and microdermabrasion can also be effective for treating PIH. However, these treatments also carry a risk of harmful side effects, and may ultimately exacerbate PIH if performed incorrectly.
PIH can be effectively prevented and managed with a skin care routine that emphasizes sun protection, moisturization with noncomedogenic ingredients and the use of gentle, nonirritating cleansers, toners and exfoliants.
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